Category: health care Page 30 of 35

Is that Americans (and Westerners as a group) eat crappy food and don’t get enough exercise.

The author is entirely right that real healthcare reform would tackle these problems. Frankly, if it was up to me, I’d subsidize healthy food (so it’s cheaper than junk food) and heavily tax unhealthy food.  Exercise would be mandatory in all schools, and it would be real exercise, meaning every kid who could handle it would be getting a minimum of half an hour of cardio  3 days a week, and would learn how to use weights as well as being exposed to some form of skilled movement exercise, whether that be climbing, dance, yoga, tai-chi or something else along those lines.  Every kid, when graduating, would be able to put together an exercise program on their own, so that if they needed to in the future, they could.

No mortgage would be considered to be “conforming” for federal mortgage guarantees if the neighbourhood it was in did not have sidewalks, city centers would be off-limit to all cars, with only emergency vehicles allowed in during the day, and commercial vehicles delivering at night.

Etc…  Yes, this might infringe on the holy right of Westerners to be lazy, fat and sick, but so be it.

While I’m enjoying seeing some Progressives come out against the Senate bill, noting that it’s worse than nothing, the fact of the matter is that the House Bill wasn’t that much better.  The public option in the House bill was so weak that insurance provided by it was expected to have higher premiums than private plans, and while the subsidies were more generous they weren’t so high that they wouldn’t have driven many folks into bankruptcy.

I am heartened that there was a red line that some would not cross, especially my ex-colleagues at FDL, but I am mystified because the fundamental arguments that are being used apply almost as much to the House plan as the Senate plan with a few exceptions.

At this point I don’t suppose it matters.  The Senate plan is what’s going to pass, any changes to it will be minor, since Nelson and Lieberman will walk if anything major is changed and there isn’t a block of progressive Representatives with enough guts to threaten to do the same and mean it.

But I wonder if there’d been a firestorm earlier, from the left, pushing for a better House bill, if the envelope might not have been moved left enough to get a better bill.  This last minute firestorm, while welcome, seems unlikely to change anything.  Perhaps complaining earlier wouldn’t have either.  I guess we’ll never know.

Seriously, someone explain to me what is wrong with Cadillac plans.  Yes, they cost more.  That’s because they’re the only plans where you stand a chance of actually getting the care you really need, when you need it, and not going bankrupt.  We should want more of them, but that can’t be done because we can’t afford it.

Unless, of course, the US went to something rational—like, say, Medicare-for-all, instead of trying to reinvent the wheel.  Why?  Because Medicare-for-all would cut health care costs by at least a third.

The health care crisis  isn’t about people not having insurance, it’s about people not getting the health care they need when they need it without having to pay money they can’t afford.  When I go to a Canadian hospital, I never, ever, even see a bill.

And unless you’re a multi-millionaire, I get better care than you get too.

Mandos says yes, at his place.

Krugman:

And maybe I’m being unfair, but I don’t seem to see the same degree of soul-searching on the other side. Too much of what I read seems to come from people who haven’t really faced up to what it will mean for progressive hopes — not to mention America’s uninsured — if health care reform crashes and burns, yet again.

What it will mean is not forcing people who can’t afford insurance to buy insurance they can’t, well, afford.  And bad insurance at that.

I think the Raven nails it when it writes:

I’m struck, in reading the support for the disastrous Senate “health” “care” bill, how much it depends on the idea than an improvement on the average level of US health care is acceptable, even though it means that huge numbers of people will be ruined, and some will die. And I think I’m starting to see a pattern: among liberals the academics and the people with secure jobs support it (even Krugman, sigh), and the people like Ian Welsh who’ve actually been poor, or who know people who’ve been poor, oppose it. It’s easy, when dealing with numbers, to forget that each click on the counter signifies a whole life: hopes and fears and dreams. I want us to remember.

A whole life and all its fears and dreams.  How many will be destroyed by this bill?  I won’t pretend that politics shouldn’t be about doing the most good for the most people, but sometimes the price in destroyed lives is too high for marginal improvement in other people’s lives.  (See reduced consumer costs in exchange for making people unemployed, aka: “free” trade.)

Nate Silver has some questions for those who want the health care bill to die. Since many of these questions are common ones, here are answers.

1. Over the medium term, how many other opportunities will exist to provide in excess of $100 billion per year in public subsidies to poor and sick people?

a. Over the medium term, how many other opportunities will exist to force people to spend money they don’t have on insurance that doesn’t have a cap on expenses and in some cases only has a 70% actuarial value?  100 billion in subsidies doesn’t mean squat if they come tied to an expense people can’t afford, making them buy insurance which is not particularly useful.

2. Would a bill that contained $50 billion in additional subsidies for people making less than 250% of poverty be acceptable?

No.  Even at 300% or 401% (sbusidies cutting off at 400%), there are people who will be forced into bankruptcy by this bill.  Repeat after me, no cap on expenses, and inadequate cost controls.

3. Where is the evidence that the plan, as constructed, would substantially increase insurance industry profit margins, particularly when it is funded in part via a tax on insurers?

Stock values of pharma, insurance companies and healthcare companies in general are up, that’s because the market thinks the plan will increase their profits.  Where is the evidence that forcing 30 million people to buy a product with actuarial values as low as 70% wouldn’t increase profits?

4. Why are some of the same people who are criticizing the bill’s lack of cost control also criticizing the inclusion of the excise tax, which is one of the few cost control mechanisms to have survived the process?

Because the excise tax is not inflation adjusted, which means that over time it will force companies to reduce the quality of their plans.

5. Why are some of the same people who are criticizing the bill’s lack of cost control also criticizing the inclusion of the individual mandate, which is key to controlling premiums in the individual market?

Because the mandate, as noted above, will force people who can’t afford insurance to buy bad insurance.  Also, if you take a look at Massachussets, where they have a mandate, you will find little evidence that a mandate has controlled costs.  A mandate by itself is not sufficient to control costs, all it does is set up a company shop.  Absent hard regulation of the sort of the US has proven very bad at enforcing (see Crisis, Financial) a mandate is just a looting license.

6. Would concerns about the political downside to the individual mandate in fact substantially be altered if a public plan were included among the choices? Might not the Republican talking point become: “forcing you to buy government-run insurance?”

Not if it were a robust public option which reduced costs.  Good policy makes people happy.  And no one would be forced to buy the public option anyway, it’s an option. Only one of many choices.

7. Roughly how many people would in fact meet ALL of the following criteria: (i) in the individual insurance market, and not eligible for Medicaid or Medicare; (ii) consider the insurance to be a bad deal, even after substantial government subsidies; (iii) are not knowingly gaming the system by waiting to buy insurance until they become sick; (iv) are not exempt from the individual mandate penalty because of low income status or other exemptions carved out by the bill?

How many people are going bankrupt a year now?  Well, in the first 9 months of the year, 1,046,449.  Average that out for the year, and assume we hit something over 1.3 million.  Now, how many MORE people would go bankrupt if they were forced to spend money they don’t have on insurance they can’t afford, which has no caps on expenditures and when things were getting tight couldn’t dump that insurance?

8. How many years is it likely to be before Democrats again have (i) at least as many non-Blue Dog seats in the Congress as they do now, and (ii) a President in the White House who would not veto an ambitious health care bill?

They already have a president in the Whitehouse who doesn’t want an ambitious health care bill and has worked hard to make sure there isn’t one.  Here’s my question for you.  Given cost realities, which no, this bill doesn’t address, how many years will it be before it will be even more clear that something has to be done?  But in any case, pushing through a bill which is worse than the status quo is not a victory, so this question is a non-sequitur.

9. If the idea is to wait for a complete meltdown of the health care system, how likely is it that our country will respond to such a crisis in a rational fashion? How have we tended to respond to such crises in the past?

Well, in the Great Depression the US responded quite well.  Of course, there’s a 50/50 chance that instead of getting an FDR you may get something much worse, but again, passing a bad bill now isn’t superior to passing no bill at all, so this is a non-question.

10. Where is the evidence that the public option is particularly important to base voters and/or swing voters (rather than activists), as compared with other aspects of health care reform?

Well, the public option has regularly polled as popular, and in the meantime 40% of democratic voters are currently stating that they are so demoralized they are thinking of staying home in 2010. We can’t know how much of that is related to this lousy healthcare plan, but given that healthcare has dominated the news from DC for, oh, 6 months, I think it would be surprising if it wasn’t a huge factor.

11. Would base voters be less likely to turn out in 2010 if no health care plan is passed at all, rather than a reasonable plan without a public option?

I don’t know, and neither do you.  What I do know is that doing something bad is worse than doing nothing at all.

12. What is the approximate likelihood that a plan passed through reconciliation would be better, on balance, from a policy perspective, than a bill passed through regular order but without a public option?

Very high, since it is 3 or 4 Senators who keep blackmailing out the better parts of the bills, and reconciliation needs only 51 votes.

13. What is the likely extent of political fallout that might result from an attempt to use the reconciliation process?

Well, Bush used it to pass tax cuts for the rich, and no one seemed to care much.  Granted Democrats aren’t allowed to do what Republicans do.  Probably you’d have a hard time passing anything till the next election that didn’t require reconciliation, or which you didn’t stick in a miltiary funding bill.  But so what?  Getting through one really good bill, and with reconciliation you could put through a bill with a real public option, not the watered down House version, would be worth it.  Except, of course, that the President doesn’t want a good bill.  But, again, this is a bad bill.

14. How certain is it that a plan passed through reconciliation would in fact receive 51 votes (when some Democrats would might have objections to the use of the process)?

Not completely certain.  But again, if it fails, I don’t care.  This bill is bad, if it dies, it dies.  Better no bill, than a bad bill.

15. Are there any compromises or concessions not having to do with the provision of publicly-run health programs that could still be achieved through progressive pressure?

Can’t think of anything significant offhand.

16. What are the chances that improvements can be made around the margins of the plan — possibly including a public option — between 2011 and the bill’s implementation in 2014?

Since indications are that Democrats will lose seats in 2010, not much.

17. What are the potential upsides and downsides to using the 2010 midterms as a referendum on the public option, with the goal of achieving a ‘mandate’ for a public option that could be inserted via reconciliation?

Can’t be done.  The Democratic party is not willing to run  on it, and progressives cannot run on it alone.  Again, there is no indication the President wanted a public option, certainly none that he pushed for it any meaningful way.

18. Was the public option ever an attainable near-term political goal?

Yes.  The President wants a bill very badly.  If Progressive legislators were willing to walk, they would have bargaining leverage.

19. How many of the arguments that you might be making against the bill would you still be making if a public option were included (but in fact have little to do with the public option)?

Frankly the House public option was already so weak that the bill was already dead to me.  Reconciliation is only useful if it offers a chance to get a better public option than the House public option.

20. How many of the arguments that you might be making against the bill are being made out of anger, frustration, or a desire to ring Joe Lieberman by his scruffy, no-good, backstabbing neck?

I have been against this bill for a couple months now.  Any frustration I have is only because the bill is so bad it needs to die.

(Wrote this August 31st.  I think it deserves a bump back to the top.  Remember, the CBO has said that the public option will have higher premiums than private insurance due to a higher cost structure.)

To put it really simply, if you don’t need a profit, and if you are only as efficient as your competitors, you will drive them out of business if you are not constrained in some fashion from doing so. Capital is the usual fashion to wipe out competitors, since non profits have trouble raising it.  In the context of health care, arranging it so the public option takes on more unhealthy people is the more likely way to do it.

Since a real public option properly created to not be constrained from doing so WILL drive private insurers out of business, it will not be allowed to happen. It may be called a “public option”, but it won’t actually be allowed to operate as a public option should. A public option which won’t destroy the insurers in time, is also a public option which can’t drive down prices effectively.

All else is shadow play.